Organization Name: | NORTHSIDE PARK GASTROENTEROLOGY & ENDOSCOPY CENTER PLLC |
NPI Number: | 1336422302 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL SUE (PHYSICIAN/OWNER) |
Mailing Address: | 102 Northside Park Dr Elizabeth City |
State: | NC US |
Postal Code: | 27909 |
Phone Number: | 2523354619 |
Fax Number: | 2523355744 |
NPI Enumeration Date: | 09/26/2011 |
NPI Last Update Date: | 10/22/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 151718 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |